FUTURE OFDENTISTRYequal amounts of payment for dental care, each at
about 47% of the total, with government-financed
care accounting for 4%, and other private funds
accounting for about 2%. (HCFA expenditure data
do not include free/charitable dental services.)
As noted, private prepayment dental plans en-
hance demand for care, and thus, access.
Prepayment encourages people to receive routine
preventive care and early detection of dental prob-
lems. Enrollment in employer-based dental prepay-
ment is about 105 million people and has increased
slowly in the past 10 years with the expanding econ-
omy. As part of the general shifts in the financing of
dental care, membership in indemnity plans is
declining and enrollment in Preferred Provider
Organizations (PPO) is increasing. However,
Dental Health Maintenance Organization (Dental
HMO) plan membership is not growing at the same
rate as PPOs. To date, capitated managed care has
had relatively little impact on dental expenditures in
most geographic areas of the country.
Public financing of services for economically dis-
advantaged populations has remained fairly con-
stant. Annual federal and state government dental
care payment for the 35 million people eligible for
Medicaid is about $40 to $70 per person compared
to the approximately $200 to $300 per person spent
among the non-poor. While improvements are
being made in some states, Medicaid reimbursement
levels, ranging from 10-50% of market fees, are
grossly inadequate.
Patients pay approximately 47% of total dental
expenditures, or $25.8 billion (HCFA). This in-
cludes cost sharing and contribution to premiums
for patients with dental prepayment and the full
out-of-pocket payments for those without prepay-
ment. This pattern of out-of-pocket patient costs
has been relatively stable for the past 10 years
Federal and state government payment for dental
services was $2.3 billion in 1998, 4.2% of total den-
tal expenditures (HCFA). Most public funds sup-
port state operated Medicaid programs for low-
income individuals that meet state program criteria.
Medicaid dental services support is provided mainly
to children. Few states cover indigent adults for
basic dental services.
On average dentists receive less than half their
usual and customary fees when paid by MedicaidFinancing of and Access to Dental Services
Per Capita Total Dental Expenditures
Per Capita Other Private Funds
Per Capita Out-of-Pocket PaymentsPer Capita Public Funds (e.g., Medicaid)
Per Capita Private Health InsuranceSource: Health Care Financing Administration and U.S. Department of Labor, Consumer Price Index, Bureau of Labor Statistics.250200150100500FIGURE 4.3Total Real (Base=1998) per Capita Dental Expenditures,
by Type of Payment, 1970 - 1998DOLLARSYEAR19701974 1978 19821986 19901994 1998